From sinusitis to orbital cellulitis, there’s a plethora of EENT disorders, and any one of them can surface on the Physician Assistant Exams (PANCE/PANRE). These practice questions are similar to the PANCE questions you may see about eye, ear, nose, and throat conditions.

Example PANCE Questions

You’re evaluating a 34-year-old woman who presents with dizziness, vertigo, and tinnitus in the right ear. She is also complaining of drainage in the right ear. She denies any prior cold, upper respiratory infection, or focal weakness. Which one of the following is her likely diagnosis?

(A) Salicylate toxicity

(B) Labrynthitis

(C) Benign paroxysmal positional vertigo

(D) Ménière’s disease

(E) Acute sinusitis

Which of the following medications is ototoxic?

(A) Gentamicin

(B) Doxycycline (Vibramycin)

(C) Cefazolin (Ancef)

(D) Metronidazole (Flagyl)

(E) Clarithromycin (Biaxin)

You’re evaluating a 67-year-old man who was involved in a motor vehicle accident. On physical examination, you notice a significant restriction of right eye movement. Which of the following would you order next?

(A) Radiograph of the orbit

(B) CT scan of the orbit

(C) MRI of the head without gadolinium

(D) Skull radiograph

(E) PET scan

Which of the following muscles is innervated by cranial nerve IV?

(A) Superior oblique

(B) Lateral rectus

(C) Eyelid

(D) Forehead

(E) Trapezius

Which one of the following conditions is a complication of acute otitis media?

(A) Sinusitis

(B) Pharyrngitis

(C) Meningitis

(D) Peritonsillar abscess

(E) Dacryoadenitis

Which one of the following would be a cause of sensorineural hearing loss?

(A) Cerumen impaction

(B) Flying in a plane at high altitude

(C) Otitis externa

(D) Ménière’s disease

(E) Otitis media

Example PANCE Answers and Explanations

Use this answer key to score the practice questions. The answer explanations give you some insight into why the correct answer is better than the other choices.

1. D. This woman has multiple symptoms affecting one ear, and they point to Ménière’s disease as the likely diagnosis. Choice (B), labrynthitis, is usually due to a prior upper respiratory infection. Choice (C), benign paroxysmal positional vertigo, would present with vertigo-like symptoms but not the accompanying symptoms. Choice (E), acute sinusitis, would present with sinus congestion, fever, Eustachian tube dysfunction, rhinorrhea, and so forth.

2. A. Gentamicin is an aminoglycoside antibiotic. The two main classes of medications that are ototoxic are loop diuretics and aminoglycoside antibiotics, which are both nephrotoxic and ototoxic.

3. B. This man who suffered a motor vehicle accident has a blowout fracture. If the extraocular muscles are restricted, which is a possible effect, then you should order a CT scan of the orbit. None of the other choices apply in this situation.

4. A. Expect to see some questions about the cranial nerves on the PANCE. The superior oblique muscle, Choice (A), is an extraocular muscle innervated by cranial nerve IV. The lateral rectus, Choice (B), is innervated by cranial nerve VI. The eyelid, Choice (C), is innervated by cranial nerve VII to close the eyelid. The forehead, Choice (D), is innervated by cranial nerve VII, too. The trapezius, Choice (E), is innervated by the cranial nerve XI.

5. C. Meningitis is a complication of acute otitis media. Peritonsillar abscess, Choice (D), can be a complication of pharyngitis. Dacryoadenitis, Choice (E), is blockage of a lacrimal duct because of a bacterial infection.

6. D. On a test, be able to differentiate between conductive hearing loss and sensorineural hearing loss. Cerumen impaction, flying in a plane at high altitude, otitis externa, and otitis media — all the choices except Choice (D) — are causes of conductive hearing loss. Think of conductive hearing loss as beginning in the outer part of the ear up to the middle part of the ear. Sensorineural hearing loss concerns problems that affect the inner ear, such as Ménière’s disease, Choice (D).